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FUNCTIONAL STATE OF THE PSYCHOEMOTIONAL STATE IN
PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE
AFTER CORONАVIRUS INFECTION.
Phd
.Bokieva Sharofovna
Phd .
docent Tilloyeva Shakhlo Shavkatovna
Bukhara innovative university of education and
medicine Republic of Uzbekistan
Bukhara state medical institute Republic of Uzbekistan
Resume.
To study the quality of life, the psychoemotional state and the effect
of complex therapy on the parameters of the ventilation-perfusion function of the
lang and the parameters of the diastolic function of the right ventricle of the heart
in patients with chronic obstructive pulmonary disease after coronavirus infection.
Key words:
chronic obstructive pulmonary disease, coronavirus infection,
right ventricular hypertrophy, vascular endothelial function, diastolic dysfunction
of the right ventricle
Relevance.
Chronic obstructive pulmonary disease (COPD), as a cause of
death, ranks 4th in the world in the age group over 45 years old and is the only
disease in which mortality continues to increase. Due to the widespread
prevalence of COPD, direct medical and indirect costs associated with morbidity
and premature mortality pose a serious economic and social problem for society in
general and health authorities in particular [1,2].
Obviously, only in-depth studying all aspects of this disease will help find a
way out of the current impasse. Chronic obstructive pulmonary disease is one of
the leading diseases leading to disability, and tends to a steady increase in primary
cases in both industrialized and developing countries [3,8] . The risk of COPD
varies from 1.85 to 2.88 per 1,000 population. According to the conclusion of the
World Health Organization, in the last 10 years, COPD among the causes of death
is in 4th place, being the cause of 4.9% of deaths of all diseases. According to
experts' forecasts, by 2020, COPD will take 3rd place in the structure of total
mortality [7,8,26]. The acute hypoxemic patients may experience dyspnoea that
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may persist despite the administration of oxygen flows >10-15 L/min with a
reservoir mask [3,15]. In these cases, other devices, such as High-Flow Nasal
Oxygen (HFNO) or the application of Continuous Positive Airways Pressure
(CPAP) or Non-Invasive Ventilation (NIV) may be useful. However, it is
important to point out that these interventions have to be used only in appropriate
hospital settings in order to be prepared for a more aggressive treatment. When
indicated, the administration of CPAP/NIV can be carried out with various
interfaces, depending on the availability and indications (oro-nasal mask, total
face or helmet). When using CPAP/NIV, it is important to consider the potential
environmental diffusion of aerosol particles of the virus [12]. In particular, one of
the critical issues of the SARS-Cov-2 in the intermediate phase (between the onset
of disease and potential critical evolution, also in relation to comorbidity) is
represented by the selection of oxygen therapy and the level of care. Non-invasive
supports (CPAP, NIV and HFNO) can correct hypoxemia and respiratory failure
(even in the absence of clear evidence from proper randomized controlled
studies), delaying or avoiding endotracheal intubation (and its potential
complications and effects on the outcome) [14,20]. However, looking at SARS
epidemic data, physiotherapists have to be careful when treating these patients
because there is evidence that NIV may increase the risk of aerial spreading of the
virus [11,16]. Thus, if a patient shows prognostic factors suggesting the need of
invasive ventilation [17,16, 19], it is preferable to carry out elective intubation,
rather than emergency intubation in critical conditions.
Along with smoking, industrial pollutants, such as dust, gases, smoke, toxic
aerosols, are becoming an important risk factor for the development of COPD,
which significantly increase the frequency and severity of the disease [9]. The
data given in the literature by domestic and foreign authors indicate that about 15–
20% of all cases of COPD are associated with professional activity [5,4,9].
Chronic obstructive pulmonary disease is essentially a disease with features
of a destructive process, as a result of which damage to the entire respiratory
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system develops, including the bronchi up to the terminal bronchioles,
parenchyma and interstitium [1,10]. An important feature of the pathological
process in COPD is its low reversibility [2]. The main method of treatment for
such patients has long been the use of bronchodilators, starting with belladonna.
However, as new knowledge about the essence of pathology was gained, new
approaches to therapy were developed [8]. First of all, it became clear that COPD
patients are not the same. They differ in the course of the disease, in
symptomatology, in prognosis, in response to one or another therapy, which is
defined as phenotypes [4,7,8].
The aim of the study was to study pulmonary hemodynamics and diastolic
dysfunction of the right ventricle (RV) in patients with chronic obstructive
pulmonary disease COPD in dynamics, combination therapy with calcium channel
antagonists is recommended to improve pulmonary hemodynamics and bronchial
patency[14,7,18].
Materials and methods.
Thirty-five patients with COPD and 20 healthy
individuals (AP) were examined. In patients, according to Doppler
echocardiography parameters, PH (the level of mean pulmonary arterial pressure
LAPav> 25 mm Hg) and the presence of RV without PH (thickness of the anterior
wall of the RV according to EchoCG <5 mm, with anteroposterior size of the RV>
2.5 cm ). Patients were divided into 2 groups and a, b subgroups: 1a - gr. control
group (CG) 8 patients with COPD with PH; 1b - column 7 patients with COPD
with PDG received basic therapy (BT, GINA 2006), 2a - gr. 10 patients with
COPD with PH; 2b - column 8 patients with COPD with PDG received BT and a
combination of calcium antagonist dihydropyridine series amlodipine (A). For 10
days, patients received against the background of BT received a combination of a
calcium antagonist of the dihydropyridine series amlodipine (An) 2.5-5 mg / day.
FVC), forced expiratory volume in 1 sec (FEV1) and Tiffeneau's index (FEV1 /
FVC); the study of peripheral blood flow-endothelium-dependent vasodilation
(EDVD) was carried out with an ultrasound device SonoScape SSI-8000 (China);
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blood oxygen saturation (SaO2) was assessed using the pulse oximetric method
"OXY" (Germany); Doppler echocardiography was evaluated using a Vivid S60
ultrasound machine (Sweden) and SonoScape SSI-8000 (China) in accordance
with the recommendations of the American Society. The results were processed
using the Excel software package using the Student's t-test. Differences between
the studied parameters were considered significant at p <0.05.
Results and discussion.
Before treatment in conditions of increased
myocardial oxygen demand in patients, there was a violation of the parameters of
endothelium-dependent vasodilation: a decrease in the maximum blood flow
velocity in the brachial artery after a reactive test (Vmax) - by 18, 9 (1st group)
versus 28.4% (2nd); an increase in the index of circulatory resistance (ICR) - by
18.2 and 29.1% (p <0.001 in relation to the control group). The data obtained
correspond to the opinion of A.G. Chuchalin. [7] that the intensification of
inflammatory phenomena leads not only to local changes, but also to significant
systemic changes. Thus, disturbances in the peripheral mechanisms of regulation
of vascular tone develop earlier and more significantly in patients with PH and
COPD compared to COPD with PDG (p <0.05, in relation to indicators of PL)
(figure).
Picture. Parameters of EDVP and FVD in patients with COPD in the
dynamics of complex treatment.
0
10
20
30
40
50
60
70
80
90
100
FEV1,%
SaO2,%
IVRT, mc
82.5
95.9
53.6
45,23**
86,54*
86,58**
52,3**
87**
82,58**
2б
1 б
СГ
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According to FVD, there was a decrease in the ventilation state of the
bronchopulmonary system in all patients with PH and PDG. Thus, the FEV1 index
in all patients was -46.1 ± 1.6%, (p <0.005), SaO2, respectively, 89.6 ± 1.4% (p
<0.05), which is typical for an increase in bronchial obstruction. The results
obtained revealed the relationship between the clinical course, an increase in LAP
avg. and ventilation and perfusion disorders in patients with COPD.
There was a tendency towards a more pronounced decrease in the atrial
filling fraction (FPF,%) of the pancreas in patients with COPD 2 - gr. LH and RV
of subgroups, respectively, by 1.05 and 1.08 times; and an increase in the time of
deceleration of the maximum speed of early diastolic filling (VZ, m / s) by 1.07
and 1.15 times; a decrease in the ratio of early and late diastolic filling (E \ A) by
1.17 and 1.45 times, respectively (p <0.05), which indicates an increase in
myocardial stiffness and impaired passive relaxation.
After the therapy, there is an improvement in the studied parameters. Positive
correlations were revealed between SaO2: isovolumic relaxation time (VIR, m / s)
and VZ, respectively, 0.40 and 0.35 (p <0.05). After treatment in 2-gr. LH and
RVD subgroups, in patients, the blood SaO2 values increased to 89.8 ± 0.7 and
92.3 ± 0.6%, respectively, by 1.10 and 1.16 times lower than the LP indicators (p
<0.05). In the dynamics of the complex treatment with Am E \ A, the indicators
increased by 7.9 and 4.0%, respectively, and the mean pulmonary artery pressure
(LAPav) by 1.20 and 1.16 times (p <0.01). The use of BT alone does not have a
significant effect on the parameters of pulmonary hemodynamics, providing only
a decrease in LADav.
Correlation analysis showed that the increase in obstruction and hypoxemia
are closely associated with the development of diastolic dysfunction of the
pancreas. At the same time, the severity of the increase in LADav. has a
significant dependence on the severity of COPD.
In our study, the use of amlodipine 2.5-5 mg / day against the background of
BT in patients with COPD with PH led not only to a decrease in PAP avg., but
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was also accompanied by a positive shift in ventilation-perfusion lung capacity in
group 2 of patients by 10.5% (p <0.01). LAD Wed after treatment in group 2
decreased by 15.7% (significance of the difference with the indicators before
treatment p <0.05). It should be noted that in patients with COPD and PH with an
increase in PAP avg. changes in the structure of filling the pancreas in diastole.
The mutual aggravation of disorders in the combination of cardiorespiratory
pathology is based on the commonality of some links of pathogenesis - disorders
of pulmonary and cardiac microcirculation, the development of hypoxemia and
pulmonary hypertension. It was found that in patients with COPD with PH
receiving amlodipine against the background of BT, there is an improvement in
the parameters of pulmonary hemodynamics and ventilation capacity and
bronchial patency of the lungs.
Conclusions.
1. Violations of the peripheral mechanisms of regulation of
vascular tone develop earlier and more significantly in severe clinical course of
COPD with an increase in PAP cf. (p <0.05).
2. Complex treatment of patients with COPD with pulmonary hypertension,
including amlodipine, reduces the tone of pulmonary vessels and simultaneously
improves endothelium-dependent vasodilation of peripheral vessels.
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